The invention relates to optically pure derivatives of (xe2x88x92)-venlafaxine, methods of their synthesis, compositions comprising them, and methods of their use.
A number of nontricyclic antidepressants have recently been developed that diminish the cardiovascular and anticholinergic liability characteristic of tricyclic antidepressants. Some of these compounds are used as anti-obesity agents and have shown promise in the treatment of cerebral function disorders such as Parkinson""s disease and senile dementia. See, e.g., WO 94/00047 and WO 94/00114. The nontricyclic compound venlafaxine, chemically named (xc2x1)-1-[2-(dimethylamino)-1 -(4-methoxyphenyl)ethyl]-cyclohexanol, is an antidepressant which has been studied extensively and which is described in, for example, U.S. Pat. No. 4,761,501 and Pant, J. T. Drugs of the Future 13(9):839-840 (1988). Its hydrochloride salt is currently commercially available in the United States under the trade name Effexor(copyright). Effexor(copyright), which is a racemic mixture of the (+) and (xe2x88x92) enantiomers of venlafaxine, is indicated for the treatment of depression.
Although venlafaxine contains an asymmetric carbon atom and is sold as a racemate, it has been reported that its (xe2x88x92) enantiomer is a more potent inhibitor of norepinephrine synaptosomal uptake while its (+) enantiomer is more selective in inhibiting serotonin uptake. Howell, S. R. et al. Xenobiotica 24(4):315-327 (1994). Furthermore, studies have shown that the ratio of the two isomers"" metabolism varies not only among species, but between subjects as well. Klamerus, K. J. et al. J. Clin. Pharmacol. 32:716-724 (1992). In humans, venlafaxine is transformed by a saturable metabolic pathway into two minor metabolites, N-desmethylvenlafaxine and N,O-didesmethylvenlafaxine, and one major metabolite, O-desmethylvenlafaxine, as shown in Scheme I(a): 
Klamerus, K. J. et al. J. Clin. Pharmacol. 32:716-724 (1992). All of these metabolites are racemic. In vitro studies suggest that O-desmethylvenlafaxine is a more potent inhibitor of norepinephrine and dopamine uptake than the parent compound racemic venlafaxine. Muth, E. A. et al. Drug Develop. Res. 23:191-199 (1991). O-desmethylvenlafaxine has also been reported to have a half-life (txc2xd) of about 10 hours, which is approximately 2.5 times as long as that of venlafaxine. Klamerus, K. J. et al. J. Clin. Pharmacol. 32:716-724 (1992). Studies directed at understanding-the activity of O-desmethylvenlafaxine as compared to its parent have been hampered, however, by the metabolic difference between laboratory animals and man in their exposure to venlafaxine. Howell, S. R. et al. Xenobiotica 24(4):315-327 (1994).
Despite the benefits of racemic venlafaxine, it has adverse effects including, but not limited to, sustained hypertension, headache, asthenia, sweating, nausea, constipation, somnolence, dry mouth, dizziness, insomnia, nervousness, anxiety, blurred or blurry vision, and abnormal ejaculation/orgasm or impotence in males. Physicians"" Desk Reference pp. 3293-3302 (53rd ed., 1999); see also Sinclair, J. et al. Rev. Contemp. Pharmacother. 9:333-344 (1998). These adverse effects can significantly limit the dose level, frequency, and duration of drug therapy. It would thus be desirable to find a compound with the advantages of venlafaxine while avoiding its disadvantages.
This invention relates to novel pharmaceutical compositions comprising optically pure derivatives of (xe2x88x92)-venlafaxine such as (xe2x88x92)-O-desmethylvenlafaxine. The invention also relates to methods of preparing optically pure derivatives of (xe2x88x92)-venlafaxine with high purity and in high yield, and to methods of treating and preventing diseases and disorders which comprise the administration of one or more optically pure derivatives of (xe2x88x92)-venlafaxine to a human in need of such treatment or prevention.
Methods and compositions of the invention can be used to treat or prevent depression and affective disorders such as, but not limited to, attention deficit disorder and attention deficit disorder with hyperactivity. Methods and compositions of the invention are also useful in treating obesity and weight gain in a human. The invention also encompasses the treatment of cerebral function disorders including, but not limited to, senile dementia, Parkinson""s disease, epilepsy, Alzheimer""s disease, amnesia/amnestic syndrome, autism and schizophrenia; disorders ameliorated by inhibition of neuronal monamine reuptake; and pain, particularly chronic pain. The invention further encompasses the treatment or prevention of obsessive-compulsive disorder, substance abuse, pre-menstrual syndrome, anxiety, eating disorders and migraines. The invention finally encompasses the treatment or prevention of incontinence in humans.
The compounds and compositions of the invention possess potent activity for treating or preventing the above-described disorders while reducing or avoiding adverse effects including, but not limited to, sustained hypertension, headache, asthenia, sweating, nausea, constipation, somnolence, dry mouth, dizziness, insomnia, nervousness, anxiety, blurred or blurry vision, and abnormal ejaculation/orgasm or impotence in males. In particular, adverse effects associated with the administration of racemic venlafaxine are reduced or avoided by the use of optically pure derivatives of (xe2x88x92)-venlafaxine. Compositions of the invention can also exhibit long half lives as compared to racemic venlafaxine.
Although a variety of pharmaceutical salts, solvates, clatherates and/or hydrates (including anhydrous forms) of the active ingredients disclosed herein are suitable for use in the methods and compositions of the invention, the optically pure derivatives of (xe2x88x92)-venlafaxine are typically prepared as hydrochloride salts, and preferably as the monohydrates.
As used herein, the terms xe2x80x9cvenlafaxinexe2x80x9d and xe2x80x9c(xc2x1)-venlafaxinexe2x80x9d mean the racemic compound (xc2x1)-1-[2-(dimethylamino)-1-(4-methoxyphenyl)ethyl]cyclohexanol.
As used herein, the terms xe2x80x9cvenlafaxine derivativexe2x80x9d and xe2x80x9cderivative of venlafaxinexe2x80x9d encompass, but are not limited to, human metabolites of racemic venlafaxine. In particular, the terms xe2x80x9cvenlafaxine derivativexe2x80x9d and xe2x80x9cderivative of venlafaxinexe2x80x9d mean a compound selected from the group that includes, but is not limited to: (xc2x1)-N-desmethylvenlafaxine, chemically named (‥)-1 -[2-(methylamino)-1 -(4-methoxyphenyl)ethyl] cyclohexanol; (xc2x1)-N,N-didesmethylvenlafaxine, chemically named (xc2x1)-1 -[2-(amino)-1 -(4-methoxyphenyl)ethyl]cyclohexanol; (xc2x1)-O-desmethylvenlafaxine, chemically named (xc2x1)-1-[2-(dimethylamino)-1-(4-phenol)ethyl]cyclohexanol; (xc2x1)-N,O-didesmethylvenlafaxine, chemically named (xc2x1)-1 - [2-(methylamino)-1 -(4-phenol)ethyl]cyclohexanol; and (xc2x1)-O-desmethyl-N,N-didesmethylvenlafaxine, chemically named chemically named (xc2x1)-1-[2-(amino)-1-(4-phenol)ethyl]cyclohexanol.
As used herein, the terms xe2x80x9c(xe2x88x92)-venlafaxine derivativexe2x80x9d and xe2x80x9cderivative of (xe2x88x92)-venlafaxinexe2x80x9d encompass, but are not limited to, optically pure human metabolites of (xe2x88x92)-venlafaxine. In particular, the terms xe2x80x9c(xe2x88x92)-venlafaxine derivativexe2x80x9d and xe2x80x9cderivative of (xe2x88x92)-venlafaxinexe2x80x9d mean a compound selected from the group that includes, but is not limited to: optically pure (xe2x88x92)-N-desmethylvenlafaxine, chemically named (xe2x88x92)-1-[2-(methylamino)-1-(4-methoxyphenyl)ethyl]cyclohexanol; optically pure (xe2x88x92)-N,N-didesmethylvenlafaxine, chemically named (xe2x88x92)-1-[2-(amino)-1-(4-methoxyphenyl)ethyl]cyclohexanol; optically pure (xe2x88x92)-O-desmethylvenlafaxine, chemically named (xe2x88x92)-1-[2-(dimethylamino)-1-(4-phenol)ethyl]cyclohexanol; optically pure (xe2x88x92)-N,O-didesmethylvenlafaxine, chemically named (xe2x88x92)-1-[2-(methylamino)-1-(4-phenol)ethyl]cyclohexanol; and optically pure (xe2x88x92)-O-desmethyl-N,N-didesmethylvenlafaxine, chemically named chemically named (xe2x88x92)-1-[2-(amino)-1-(4-phenol)ethyl]cyclohexanol.
As used herein, the terms xe2x80x9c(+)-venlafaxine derivativexe2x80x9d and xe2x80x9cderivative of (+)-venlafaxinexe2x80x9d encompass, but are not limited to, optically pure human metabolites of (+)-venlafaxine. In particular, the terms xe2x80x9c(+)-venlafaxine derivativexe2x80x9d and xe2x80x9cderivative of (+)-venlafaxinexe2x80x9d mean a compound selected from the group that includes, but is not limited to: optically pure (+)-N-desmethylvenlafaxine, chemically named (+)-1-[2-(methylamino)-1-(4-methoxyphenyl)ethyl]cyclohexanol; optically pure (+)-N,N-didesmethylvenlafaxine, chemically named (+)-1-[2-(amino)-1-(4-methoxyphenyl)ethyl]cyclohexanol; optically pure (+)-O-desmethylvenlafaxine, chemically named (+)-1-[2-(dimethylamino)-1-(4-phenol)ethyl]cyclohexanol; optically pure (+)-N,O-didesmethylvenlafaxine, chemically named (+)-1 -[2-(methylamino)-1-(4-phenol)ethyl]cyclohexanol; and optically pure (+)-O-desmethyl-N,N-didesmethylvenlafaxine, chemically named chemically named (+)-1-[2-(amino)-1-(4-phenol)ethyl]cyclohexanol.
As used herein to describe a compound, the term xe2x80x9csubstantially free of its (+) stereoisomerxe2x80x9d means that the compound is made up of a significantly greater proportion of its (xe2x88x92) stereoisomer than of its optical antipode (i.e., its (+) stereoisomer). In a preferred embodiment of the invention, the term xe2x80x9csubstantially free of its (+) stereoisomerxe2x80x9d means that the compound is made up of at least about 90% by weight of its (xe2x88x92) stereoisomer and about 10% by weight or less of its (+) stereoisomer. In a more preferred embodiment of the invention, the term xe2x80x9csubstantially free of its (+) stereoisomerxe2x80x9d means that the compound is made up of at least about 95% by weight of its (xe2x88x92) stereoisomer and about 5% by weight or less of its (+) stereoisomer. In an even more preferred embodiment, the term xe2x80x9csubstantially free of its (+) stereoisomerxe2x80x9d means that the compound is made up of at least about 99% by weight of its (xe2x88x92) stereoisomer and about 1% or less of its (+) stereoisomer. In another preferred embodiment, the term xe2x80x9csubstantially free of its (+) stereoisomerxe2x80x9d means that the compound is made up of nearly 100% by weight of its (xe2x88x92) stereoisomer. The above percentages are based on the total amount of the combined stereoisomers of the compound. The terms xe2x80x9csubstantially optically pure (xe2x88x92)-venlafaxine derivative,xe2x80x9d xe2x80x9coptically pure (xe2x88x92)-venlafaxine derivativexe2x80x9d and xe2x80x9c(xe2x88x92) isomer of venlafaxine derivativexe2x80x9d all refer to a derivative of (xe2x88x92)-venlafaxine that is substantially free of its (+) stereoisomer.
As used herein, the term xe2x80x9cpharmaceutically acceptable saltsxe2x80x9d refers to salts prepared from pharmaceutically acceptable non-toxic acids, including inorganic acids and organic acids. Suitable non-toxic acids include inorganic and organic acids such as acetic, benzenesulfonic, benzoic, camphorsulfonic, citric, ethenesulfonic, fumaric, gluconic, glutamic, hydrobromic, hydrochloric, isethionic, lactic, maleic, malic, mandelic, methanesulfonic, mucic, nitric, pamoic, pantothenic, phosphoric, succinic, sulfuric, tartaric acid, p-toluenesulfonic and the like. Particularly preferred are hydrochloric, hydrobromic, phosphoric, and sulfuric acids, and most particularly preferred is the hydrochloride salt.
As used herein, the term xe2x80x9caffective disorderxe2x80x9d includes depression, attention deficit disorder, attention deficit disorder with hyperactivity, bipolar and manic conditions, and the like. The terms xe2x80x9cattention deficit disorderxe2x80x9d (ADD) and xe2x80x9cattention deficit disorder with hyperactivityxe2x80x9d (ADDH), or attention deficit/hyperactivity disorder (AD/HD), are used herein in accordance with the accepted meanings as found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed., American Psychiatric Association (1997) (DSM-IV(trademark)).
As used herein, the term xe2x80x9ca method of treating depressionxe2x80x9d means relief from the symptoms of depression which include, but are not limited to, changes in mood, feelings of intense sadness, despair, mental slowing, loss of concentration, pessimistic worry, agitation, and self-deprecation. Physical changes may also be relieved, including insomnia, anorexia, weight loss, decreased energy and libido, and abnormal hormonal circadian rhythms.
As used herein, the term xe2x80x9ca method for treating obesity or weight gainxe2x80x9d means reduction of weight, relief from being overweight, relief from gaining weight, or relief from obesity; all of which are usually due to extensive consumption of food.
As used herein, the term xe2x80x9ca method of treating disorders ameliorated by inhibition of neuronal monoamine reuptakexe2x80x9d means relief from symptoms of disease states associated with abnormal neuronal monoamine levels; such symptoms are reduced by way of neuronal monoamine reuptake inhibition. Monoamines, the reuptake of which are inhibited by the compounds or compositions of the present invention, include, but are not limited to, noradrenaline (or norepinephrine), serotonin and dopamine. Disorders treated by neuronal monoamine reuptake inhibition include, but are not limited to, Parkinson""s disease and epilepsy.
As used herein, the term xe2x80x9cmethod of treating Parkinson""s diseasexe2x80x9d means relief from the symptoms of Parkinson""s disease which include, but are not limited to, slowly increasing disability in purposeful movement, tremors, bradykinesia, rigidity, and a disturbance of posture in humans.
As used herein, the term xe2x80x9ca method for treating cerebral function disordersxe2x80x9d means relief from the disease states associated with cerebral function disorders involving intellectual deficits which include but are not limited to, senile dementia, Alzheimer""s type dementia, memory loss, amnesia/amnestic syndrome, disturbances of consciousness, coma, lowering of attention, speech disorders, Parkinson""s disease, Lennox syndrome, autism, hyperkinetic syndrome and schizophrenia. Also within the meaning of cerebral function disorders are disorders caused by cerebrovascular diseases including, but not limited to, cerebral infarction, cerebral bleeding, cerebral arteriosclerosis, cerebral venous thrombosis, head injuries, and the like and where symptoms include disturbances of consciousness, senile dementia, coma, lowering of attention, speech disorders, and the like.
The terms xe2x80x9cobsessive-compulsive disorder,xe2x80x9d xe2x80x9csubstance abuse,xe2x80x9d xe2x80x9cpre-menstrual syndrome,xe2x80x9d xe2x80x9canxiety,xe2x80x9d xe2x80x9ceating disordersxe2x80x9d and xe2x80x9cmigrainexe2x80x9d are used herein in a manner consistent with their accepted meanings in the art. See, es, DSM-IV(trademark). The terms xe2x80x9cmethod of treating or preventing,xe2x80x9d xe2x80x9cmethod of treatingxe2x80x9d and xe2x80x9cmethod of preventingxe2x80x9d when used in connection with these disorders mean the amelioration, prevention or relief from the symptoms and/or effects associated with these disorders. Without being limited by any theory, the treatment or prevention of certain of these disorders may be related to the activity of the active ingredient(s) as inhibitors of serotonin uptake.
As used herein, the term xe2x80x9ca method of treating or preventing incontinencexe2x80x9d means prevention of or relief from the symptoms of incontinence including involuntary voiding of feces or urine, and dribbling or leakage or feces or urine which may be due to one or more causes including but not limited to pathology altering sphincter control, loss of cognitive function, overdistention of the bladder, hyper-reflexia and/or involuntary urethral relaxation, weakness of the muscles associated with the bladder or neurologic abnormalities.
This invention relates to optically pure derivatives of (xe2x88x92)-venlafaxine such as, but not limited to, (xe2x88x92)-O-desmethylvenlafaxine, (xe2x88x92)-N-desmethylvenlafaxine, and (xe2x88x92)-N,O-didesmethylvenlafaxine. This invention further relates to the synthesis of optically pure (xe2x88x92)-venlafaxine derivatives and to compositions (eg, pharmaceutical compositions) comprising them. The invention also relates to novel uses of the compounds disclosed herein, which constitute improvements over the use of racemic venlafaxine as well as over the optically pure isomers of venlafaxine.
One embodiment of the invention encompasses a method of treating an affective disorder in a human which comprises administering to a human in need of such treatment a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer. Venlafaxine derivatives, preferably (xe2x88x92)-O-desmethylvenlafaxine, can be used to treat an affective disorder while exhibiting a longer half life than venlafaxine and/or while avoiding or reducing adverse effects that are associated with the administration of venlafaxine.
Another embodiment of the invention encompasses a method of treating weight gain or obesity in a human which comprises administering to a human in need of weight loss or obesity therapy a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer, said amount being sufficient to reduce or prevent weight gain or obesity. Optically pure (xe2x88x92)-venlafaxine derivatives, preferably (xe2x88x92)-O-desmethylvenlafaxine, can be used to treat weight gain or obesity disorder while exhibiting a longer half life than venlafaxine and/or while avoiding or reducing adverse effects that are associated with the administration of venlafaxine.
Another embodiment of the invention encompasses a method of treating disorders ameliorated by neuronal monoamine reuptake inhibition in a human which comprises administering to a human a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer, said amount being sufficient to treat such disorders. Disorders which are ameliorated by neuronal monoamine reuptake include, but are not limited to, Parkinson""s disease, epilepsy, and depression. The optically pure derivative of (xe2x88x92)-venlafaxine may be used to treat such disorders while avoiding or reducing adverse effects associated with the administration of venlafaxine.
Optically pure, or substantially optically pure, (xe2x88x92)-venlafaxine derivatives, preferably (xe2x88x92)-O-desmethylvenlafaxine, and compositions containing them are also useful in treating cerebral function disorders. Such disorders include, but are not limited to, senile dementia, Alzheimer""s type dementia, memory loss, amnesia/amnestic syndrome, disturbance of consciousness, coma, lowering of attention, speech disorders, Parkinson""s disease, Lennox syndrome, autism, hyperkinetic syndrome and schizophrenia. Cerebral function disorders may be induced by factors including, but not limited to, cerebrovascular diseases such as cerebral infarction, cerebral bleeding, cerebral arteriosclerosis, cerebral venous thrombosis, head injuries and the like and where symptoms include disturbances of consciousness, senile dementia, coma, lowering of attention, speech disorders and the like. Thus, the invention encompasses a method of treating cerebral function disorder in a human which comprises administering to a human in need of such therapy a therapeutically effective amount of (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer. The use of an optically pure (xe2x88x92)-venlafaxine derivative, preferably optically pure (xe2x88x92)-O-desmethylvenlafaxine, is intended to provide an improvement over the use of the parent drug venlafaxine. The optically pure derivatives of the invention are more potent and yet provide an overall improved therapeutic index over venlafaxine.
Another embodiment of the invention encompasses a method of treating pain, including chronic pain, in a human which comprises administering to a human in need of such therapy a therapeutically effective amount of (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer, said amount being sufficient to alleviate the human""s pain.
Another embodiment of the invention encompasses a method of treating an obsessive-compulsive disorder in a human, which comprises administering to a human in need of such therapy a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer.
Another embodiment of the invention encompasses a method of treating or preventing substance abuse in a human, which comprises administering to a human in need of such therapy a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer.
Another embodiment of the invention encompasses a method of treating or preventing pre-menstrual syndrome in a human, which comprises administering to a human in need of such therapy a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer.
Another embodiment of the invention encompasses a method of treating anxiety in a human, which comprises administering to a human in need of such therapy a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer.
Another embodiment of the invention encompasses a method of treating an eating disorder in a human, which comprises administering to a human in need of such therapy a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer.
Another embodiment of the invention encompasses a method of treating or preventing a migraine, or migraine headaches, in a human, which comprises administering to a human in need of such therapy a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantially free of its (+) stereoisomer.
Another embodiment of the invention encompasses a method of treating or preventing incontinence in a human which comprises administering to a human in need of such therapy a therapeutically effective amount of a (xe2x88x92)-venlafaxine derivative, preferably (xe2x88x92)-O-desmethylvenlafaxine, or a pharmaceutically acceptable salt, solvate or clathrate thereof, substantilly free of its (+) stereoisomer. In particular, a (xe2x88x92)-venlafaxine derivative can be used to treat fecal incontinence, stress urinary incontinence (xe2x80x9cSUIxe2x80x9d), urinary exertional incontinence, urge incontinence, reflex incontinence, passive incontinence and overflow incontinence. In a preferred embodiments the human is an elder person of an age greater than 50 or a child of an age less than 13. Further, the invention encompasses the treatment of incontinence in patients with either loss of cognitive function, sphincter control or both. The invention is particularly well suited for the treatment or prevention of fecal incontinence and stress urinary incontinence.
Another embodiment of the invention encompasses a method of preparing (xe2x88x92)-N-desmethylvenlafaxine which comprises contacting a compound of Formula 5: 
with a reductant for a time and at a temperature sufficient to form (xc2x1)-N-desmethylvenlafaxine, and isolating (xe2x88x92)-N-desmethylvenlafaxine therefrom. A preferred reductant is BH3.Me2S.
Another embodiment of the invention encompasses a method of preparing (xe2x88x92)-N,N-didesmethylvenlafaxine which comprises contacting a compound of Formula 2: 
with a reductant for a time and at a temperature sufficient to form (xc2x1)-N,N-didesmethylvenlafaxine, and isolating (xe2x88x92)-N,N-didesmethylvenlafaxine therefrom. A preferred reductant is CoCl2/NaBH4.
Another embodiment of the invention encompasses a method of preparing (xe2x88x92)-O-desmethylvenlafaxine which comprises contacting (xe2x88x92)-venlafaxine with lithium diphenylphosphide for a time and at a temperature sufficient to form (xe2x88x92)-O-desmethylvenlafaxine.
Another embodiment of the invention encompasses a method of preparing (xe2x88x92)-O-desmethylvenlafaxine which comprises contacting (xc2x1)-venlafaxine with lithium diphenylphosphide for a time and at a temperature sufficient to form (xc2x1)-O-desmethylvenlafaxine, and isolating (xe2x88x92)-O-desmethylvenlafaxine therefrom.
Another embodiment of the invention encompasses substantially pure (xe2x88x92)-O-desmethylvenlafaxine and pharmaceutically acceptable salts, solvates, and clathrates thereof.
Another embodiment of the invention encompasses substantially pure (xe2x88x92)-N,O-didesmethylvenlafaxine and pharmaceutically acceptable salts, solvates, and clathrates thereof.
Another embodiment of the invention encompasses substantially pure (xe2x88x92)-O-desmethyl-N,N-didesmethylvenlafaxine and pharmaceutically acceptable salts, solvates, and clathrates thereof.
Another embodiment of the invention encompasses (xe2x88x92)-N-desmethylvenlafaxine and pharmaceutically acceptable salts, solvates, and clathrates thereof.
A final embodiment of the invention encompasses (xe2x88x92)-N,N-didesmethylvenlafaxine and pharmaceutically acceptable salts, solvates, and clathrates thereof.
Compounds of the invention, which can be used and prepared as described herein, are shown below in Scheme I(b): 
The synthesis of some venlafaxine derivatives has been described by Yardley, J. P. et al. J. Med. Chem. 33:2899-2905 (1990), the disclosure of which is hereby incorporated by reference. This method, which may be adapted for the synthesis of the compounds of this invention, is shown in Scheme II: 
wherein R is methoxy or hydroxy, R1 is hydrogen or methyl, and the reaction conditions are as follows: (a) LDA in cycloalkanone at xe2x88x9278xc2x0 C.; (b) Rh/Al2O3; and (c) HCHO, HCOOH, H2O , reflux. The (xe2x88x92) isomer of the racemic final product yielded by step (c) may be isolated by any method known to those skilled in the art, including high performance liquid chromatography (HPLC) and the formation and crystallization of chiral salts. See, e.g., Jacques, J., et al., Enantiomers, Racemates and Resolutions, (Wiley-Interscience, New York, 1981); Wilen, S. H., et al., Tetrahedron 33:2725 (1977); Eliel, E. L. Stereochemistry of Carbon Compounds (McGraw-Hill, N.Y., 1962); and Wilen, S. H. Tables of Resolving Agents and Optical Resolutions p. 268 (E. L. Eliel, Ed. Univ. of Notre Dame Press, Notre Dame, Ind., 1972). As used herein, the term xe2x80x9cisolatexe2x80x9d encompasses the isolation of a compound from a reaction mixture, the purification of the compound, and the optical resolution of the compound.
In a preferred method of the invention, (xe2x88x92)-N,N-didesmethylvenlafaxine is prepared from (xc2x1)-N,N-didesmethylvenlafaxine, which itself is preferably prepared according to the method shown in Scheme III: 
According to this method, cyclohexanone is reacted with compound 1 to provide compound 2. This reaction is preferably done in the presence of a catalyst such as, but not limited to, lithium diisopropylamide (LDA), and in an aprotic solvent such as, but not limited to, THF.
The cyano group of compound 2 is subsequently contacted with a reductant to provide compound 3, (xc2x1)-N,N-didesmethylvenlafaxine. A preferred reductant is CoCl2/NaBH4 in methanol, although other reductants known to those skilled in the art can also be used. Salts of (xc2x1)-N,N-didesmethylvenlafaxine, such as the HCl salt (compound 4), can then be formed using reaction conditions well known in the art. (xe2x88x92)-N,N-didesmethylvenlafaxine can be isolated from (xc2x1)-N,N-didesmethylvenlafaxine using methods known in the art (e.g., by the formation of a chiral salt or using chiral chromatography).
Referring again to Scheme III, (xe2x88x92)-N,N-didesmethylvenlafaxine can alternatively be prepared from the appropriate enantiomer of compound 2. Optically pure enantiomers of compound 2 can be isolated using methods known in the art (e.g., by the formation of a chiral salt or using chiral chromatography).
In another preferred method of the invention, (xe2x88x92)-N-desmethylvenlafaxine is prepared from (xc2x1)-N-desmethylvenlafaxine, which itself is prepared from (xc2x1)-N,N-didesmethylvenlafaxine according to the method shown in Scheme IV: 
According to this method, (xc2x1)-N,N-didesmethylvenlafaxine (compound 3) is converted to compound 5 using, for example, HCO2H in a solvent such as, but not limited to, toluene. The aldehyde of compound 5 is subsequently reduced to provide compound 6, (xc2x1)-N-desmethylvenlafaxine. A preferred reductant is BH3.Me2S in an aprotic solvent such as, but not limited to, THF. Salts of (xc2x1)-N-desmethylvenlafaxine, such as the HCl salt (compound 7), can then be formed using reaction conditions well known in the art. (xe2x88x92)-N-desmethylvenlafaxine can be isolated from (xc2x1)-N-desmethylvenlafaxine using methods known in the art (e.g., by the formation of a chiral salt or using chiral chromatography).
Referring again to Scheme IV, (xe2x88x92)-N-desmethylvenlafaxine can alternatively be prepared from the appropriate enantiomers of compounds 3 or 5. Optically pure enantiomers of compounds 3 and 5 can be isolated using methods known in the art (e.g., by the formation of a chiral salt or using chiral chromatography).
It is also possible to prepare the compounds of the invention from racemic venlafaxine, which can be prepared according to methods disclosed, for example, by U.S. Pat. No. 4,761,501 and Pento, J. T. Drugs of the Future 13(9):839-840 (1988), both of which are incorporated herein by reference. Optically pure (xe2x88x92)-venlafaxine can be isolated from the racemic mixture by conventional means such as those described above, and then selectively demethylated according to methods known to those skilled in the art. See, e.g., March, J. Advanced Organic Chemistry p. 361 (3rd ed. 1985).
In a preferred method of the invention, optically pure (xe2x88x92)-venlafaxine is isolated from (xc2x1)-venlafaxine according to the method shown in Scheme V: 
According to this method, (xe2x88x92)-venlafaxine (compound 9) is isolated from (xc2x1)-venlafaxine (compound 8) by forming a chiral salt using, for example, di-p-toluoyl-D-tartaric acid. Salts of (xe2x88x92)-venlafaxine, such as the HCl salt (compound 10), can then be formed using reaction conditions well known in the art.
Compounds of the invention are readily prepared from (xe2x88x92)-venlafaxine. For example, in a preferred method of the invention, (xe2x88x92)-O-desmethylvenlafaxine is prepared from (xe2x88x92)-venlafaxine as shown in Scheme VI: 
According to this method, the methoxy group of (xe2x88x92)-venlafaxine (compound 9) is converted to an alcohol to provide (xe2x88x92)-O-desmethylvenlafaxine (compound 1 1) using, for example, lithium diphenylphosphide.
Alternative methods of preparing (xc2x1)-venlafaxine HCl and (xc2x1)-O-desmethyl-venlafaxine, from which optically pure (xe2x88x92)-venlafaxine derivatives can be prepared using methods such as those described herein, are shown in Scheme VII: 
According to Scheme VII, (xc2x1)-venlafaxine (compound 8) is prepared by reacting (xc2x1)-N,N-didesmethylvenlafaxine (compound 3) with, for example, HCHO/HCO2H. Compound 8 can then be converted to (xc2x1)-O-desmethylvenlafaxine (compound 13) using, for example, lithium diphenylphosphide. Alternatively, salts of (xc2x1)-venlafaxine, such as the HCl salt (compound 12), can be formed using reaction conditions well known in the art. Optically pure enantiomers of compounds 12 and 13 can be isolated using methods known to those skilled in the art (e.g., by the formation of a chiral salt or using chiral chromatography). Optically pure enantiomers of compounds 12 and 13 can also be prepared according to Scheme VII by beginning with the corresponding optically pure enantiomers of compound 8.
Utilizing the optically pure or substantially optically pure derivatives of (xe2x88x92)-venlafaxine in the treatment and/or mitigation of the conditions described herein results in clearer dose-related definitions of efficacy, diminished adverse effects, and accordingly an improved therapeutic index as compared to venlafaxine itself.
The magnitude of a prophylactic or therapeutic dose of a (xe2x88x92)-venlafaxine derivative (herein also referred to as an xe2x80x9cactive ingredientxe2x80x9d), preferably (xe2x88x92)-O-desmethylvenlafaxine, in the acute or chronic management of a disease will vary with the severity of the condition to be treated and the route of administration. The dose, and perhaps the dose frequency, will also vary according to age, body weight, response, and the past medical history of the individual patient. In general, the recommended daily dose range for the conditions described herein lie within the range of from about 10 mg to about 1000 mg per day, given as a single once-a-day dose in the morning but preferably as divided doses throughout the day taken with food. Preferably, a daily dose range should be from about 50 mg to about 500 mg per day, more preferably, between about 75 mg and about 350 mg per day. In managing the patient, the therapy should be initiated at a lower dose, perhaps about 50 mg to about 75 mg, and increased if necessary up to about 250 mg to about 325 mg per day as either a single dose or divided doses, depending on the patient""s global response. If a dosage is increased, it is preferably done in intervals of about 75 mg separated by at least 4 days.
Because elimination of (xe2x88x92)-venlafaxine derivatives from the bloodstream is dependant on renal and liver function, it is recommended that the total daily dose be reduced by at least 50% in patients with moderate hepatic impairment, and that it be reduced by 25% in patients with mild to moderate renal impairment. For patients undergoing hemodialysis, it is recommended that the total daily dose be reduced by 5% and that the dose be withheld until the dialysis treatment is completed. Because some adverse reactions have been reported for patients who took venlafaxine concurrently with, or shortly after, a monamine oxidase inhibitor, it is recommended that the (xe2x88x92)-venlafaxine derivatives of this invention not be administered to patients currently taking such inhibitors. In general, the concurrent administration of the compounds of this invention with other drugs, particularly other serotonin uptake inhibitors, should be done with care. See, es., von Moltke, L. L. et al. Biol. Psychiatry 41:377-380 (1997); and Sinclair, J. et al. Rev. Contemp. Pharmacother. 9:333-344 (1998).
The various terms xe2x80x9csaid amount being sufficient to alleviate the affective disorder,xe2x80x9d xe2x80x9csaid amount being sufficient to alleviate depression,xe2x80x9d xe2x80x9csaid amount being sufficient to alleviate attention deficit disorder,xe2x80x9d xe2x80x9csaid amount being sufficient to alleviate an obsessive-compulsive disorderxe2x80x9d, xe2x80x9csaid amount being sufficient to prevent or alleviate substance abusexe2x80x9d, xe2x80x9csaid amount being sufficient to prevent or alleviate pre-menstrual syndromexe2x80x9d, xe2x80x9csaid amount being sufficient to prevent or alleviate anxietyxe2x80x9d, xe2x80x9csaid amount being sufficient to prevent or alleviate an eating disorderxe2x80x9d, xe2x80x9csaid amount being sufficient to prevent or alleviate or prevent migrainexe2x80x9d, xe2x80x9csaid amount being sufficient to alleviate Parkinson""s disease,xe2x80x9d xe2x80x9csaid amount being sufficient to alleviate epilepsy,xe2x80x9d xe2x80x9csaid amount being sufficient to alleviate obesity or weight gain,xe2x80x9d xe2x80x9can amount sufficient to achieve weight loss,xe2x80x9d xe2x80x9csaid amount being sufficient to bring about weight reduction in a human,xe2x80x9d xe2x80x9csaid amount being sufficient to alleviate pain,xe2x80x9d xe2x80x9csaid amount being sufficient to alleviate dementia,xe2x80x9d xe2x80x9csaid amount sufficient to alleviate said disorders ameliorated by inhibition of neuronal monoamine reuptake,xe2x80x9d xe2x80x9csaid amount is sufficient to alleviate cerebral function disordersxe2x80x9d wherein said disorders are selected from the group consisting of senile dementia, Alzheimer""s type dementia, memory loss, amnesia/amnestic syndrome, disturbance of consciousness, coma, lowering of attention, speech disorders, Parkinson""s disease, Lennox syndrome, autism, hyperkinetic syndrome, schizophrenia, and cerebrovascular diseases, such as cerebral infarction, cerebral bleeding, cerebral arteriosclerosis, cerebral venous thrombosis, head injuries, and the like, xe2x80x9csaid amount being sufficient to treat or prevent incontinencexe2x80x9d wherein said incontinence includes but is not limited to fecal, stress, urinary, urinary exertional, urge, reflex, passive and overflow incontinence, are encompassed by the above described dosage amounts and dose frequency schedule. Similarly, amounts sufficient to alleviate each of the above disorders but insufficient to cause adverse effects associated with venlafaxine are also encompassed by the above described dosage amounts and dose frequency schedule.
Any suitable route of administration can be employed for providing the patient with a therapeutically or prophylactically effective dose of an active ingredient. For example, oral, mucosal (e.g., nasal, sublingual, buccal, rectal, vaginal), parenteral (e.g., intravenous, intramuscular), transdermal, and subcutaneous routes can be employed. Preferred routes of administration include oral, transdermal, and mucosal. Suitable dosage forms for such routes include, but are not limited to, transdermal patches, ophthalmic solutions, sprays, and aerosols. Transdermal compositions can also take the form of creams, lotions, and/or emulsions, which can be included in an appropriate adhesive for application to the skin or can be included in a transdermal patch of the matrix or reservoir type as are conventional in the art for this purpose. A preferred transdermal dosage form is a xe2x80x9creservoir typexe2x80x9d or xe2x80x9cmatrix typexe2x80x9d patch, which is applied to the skin and worn for a specific period of time to permit the penetration of a desired amount of active ingredient. The patch can be replaced with a fresh patch when necessary to provide constant administration of the active ingredient to the patient.
Other dosage forms of the invention include, but are not limited to, tablets, caplets, troches, lozenges, dispersions, suspensions, suppositories, ointments, cataplasms (poultices), pastes, powders, dressings, creams, plasters, solutions, capsules, soft elastic gelatin capsules, and patches.
In practical use, an active ingredient can be combined in an intimate admixture with a pharmaceutical carrier according to conventional pharmaceutical compounding techniques. The carrier can take a wide variety of forms depending on the form of preparation desired for administration. In preparing the compositions for an oral dosage form, any of the usual pharmaceutical media can be employed as carriers, such as, for example, water, glycols, oils, alcohols, flavoring agents, preservatives, coloring agents, and the like in the case of oral liquid preparations (such as suspensions, solutions, and elixirs) or aerosols; or carriers such as starches, sugars, micro-crystalline cellulose, diluents, granulating agents, lubricants, binders, and disintegrating agents can be used in the case of oral solid preparations, preferably without employing the use of lactose. For example, suitable carriers include powders, capsules, and tablets, with the solid oral preparations being preferred over the liquid preparations.
Because of their ease of administration, tablets and capsules represent the most advantageous oral dosage unit forms, in which case solid pharmaceutical carriers are employed. If desired, tablets can be coated by standard aqueous or nonaqueous techniques.
In addition to the common dosage forms set out above, an active ingredient can also be administered by controlled release means or delivery devices that are well known to those of ordinary skill in the art, such as those described in U.S. Pat. Nos.: 3,845,770; 3,916,899; 3,536,809; 3,598,123; and 4,008,719, 5,674,533, 5,059,595, 5,591,767, 5,120,548, 5,073,543, 5,639,476, 5,354,556, and 5,733,566, the disclosures of which are incorporated herein by reference. These dosage forms can be used to provide slow or controlled-release of one or more active ingredients using, for example, hydropropylmethyl cellulose, other polymer matrices, gels, permeable membranes, osmotic systems, multilayer coatings, microparticles, liposomes, or microspheres or a combination thereof to provide the desired release profile in varying proportions. Suitable controlled-release formulations known to those of ordinary skill in the art, including those described herein, can be readily selected for use with the pharmaceutical compositions of the invention. The invention thus encompasses single unit dosage forms suitable for oral administration such as, but not limited to, tablets, capsules, gelcaps, and caplets that are adapted for controlled-release.
All controlled-release pharmaceutical products have a common goal of improving drug therapy over that achieved by their non-controlled counterparts. Ideally, the use of an optimally designed controlled-release preparation in medical treatment is characterized by a minimum of drug substance being employed to cure or control the condition in a minimum amount of time. Advantages of controlled-release formulations include: 1) extended activity of the drug; 2) reduced dosage frequency; and 3) increased patient compliance. In addition, controlled-release formulations can be used to affect the time of onset of action or other characteristics, such as blood levels of the drug, and thus can affect the occurrence of side effects.
Most controlled-release formulations are designed to initially release an amount of drug that promptly produces the desired therapeutic effect, and to gradually and continually release of other amounts of drug to maintain this level of therapeutic effect over an extended period of time. In order to maintain this constant level of drug in the body, the drug must be released from the dosage form at a rate that will replace the amount of drug being metabolized and excreted from the body. Controlled-release of an active ingredient can be stimulated by various inducers, including, but not limited to, pH, temperature, enzymes, water, or other physiological conditions or compounds.
Pharmaceutical compositions of the invention suitable for oral administration can be presented as discrete dosage forms, such as capsules, cachets, or tablets, or aerosol sprays each containing a predetermined amount of an active ingredient as a powder or in granules, a solution, or a suspension in an aqueous or non-aqueous liquid, an oil-in-water emulsion, or a water-in-oil liquid emulsion. Such dosage forms can be prepared by any of the methods of pharmacy, but all methods include the step of bringing the active ingredient into association with the carrier, which constitutes one or more necessary ingredients. In general, the compositions are prepared by uniformly and intimately admixing the active ingredient with liquid carriers or finely divided solid carriers or both, and then, if necessary, shaping the product into the desired presentation.
For example, a tablet can be prepared by compression or molding, optionally with one or more accessory ingredients. Compressed tablets can be prepared by compressing in a suitable machine the active ingredient in a free-flowing form such as powder or granules, optionally mixed with an excipient such as, but not limited to, a binder, a lubricant, an inert diluent, and/or a surface active or dispersing agent. Molded tablets can be made by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent.
This invention further encompasses lactose-free pharmaceutical compositions and dosage forms. Lactose is used as an excipient in venlafaxine formulations. See, e.g., Physician ""s Desk Reference(copyright) 3294 (53rd ed., 1999). Unlike the parent drug, however, N-demethylated derivatives of (xe2x88x92)-venlafaxine (e.g., (xe2x88x92)-N-desmethylvenlafaxine and (xe2x88x92)-N,N-didesmethylvenlafaxine), are secondary or primary amines and may thus decompose over time when exposed to lactose. Consequently, compositions of the invention that comprise N-demethylated derivatives of (xe2x88x92)-venlafaxine preferably contain little, if any, lactose or other mono- or di-saccharides. As used herein, the term xe2x80x9clactose-freexe2x80x9d means that the amount of lactose present, if any, is insufficient to substantially increase the degradation rate of an active ingredient.
Lactose-free compositions of the invention can comprise excipients which are well known in the art and are listed in the USP (XXI)/NF (XVI), which is incorporated herein by reference. In general, lactose-free compositions comprise an active ingredient, a binder/filler, and a lubricant in pharmaceutically compatible and pharmaceutically acceptable amounts. Preferred lactose-free dosage forms comprise an active ingredient, microcrystalline cellulose, pre-gelatinized starch, and magnesium stearate.
This invention further encompasses anhydrous pharmaceutical compositions and dosage forms comprising an active ingredient, since water can facilitate the degradation of some compounds. For example, the addition of water (e.g., 5%) is widely accepted in the pharmaceutical arts as a means of simulating long-term storage in order to determine characteristics such as shelf-life or the stability of formulations over time. See, e.g., Jens T.
Carstensen, Drug Stability: Principles and Practice, 2d. Ed., Marcel Dekker, NY, N.Y., 1995, pp. 379-80. In effect, water and heat accelerate decomposition. Thus the effect of water on a formulation can be of great significance since moisture and/or humidity are commonly encountered during manufacture, handling, packaging, storage, shipment, and use of formulations.
Anhydrous pharmaceutical compositions and dosage forms of the invention can be prepared using anhydrous or low moisture containing ingredients and low moisture or low humidity conditions. Pharmnaceutical compositions and dosage forms of the invention which contain lactose are preferably anhydrous if substantial contact with moisture and/or humidity during manufacturing, packaging, and/or storage is expected.
An anhydrous pharmaceutical composition should be prepared and stored such that its anhydrous nature is maintained. Accordingly, anhydrous compositions are preferably packaged using materials known to prevent exposure to water such that they can be included in suitable formulary kits. Examples of suitable packaging include, but are not limited to, hermetically sealed foils, plastic or the like, unit dose containers, blister packs, and strip packs.
In this regard, the invention encompasses a method of preparing a solid pharmaceutical formulation comprising an active ingredient which method comprises admixing under anhydrous or low moisture/humidity conditions the active ingredient and an excipient (e.g., lactose), wherein the ingredients are substantially free of water. The method can further comprise packaging the anhydrous or non-hygroscopic solid formulation under low moisture conditions. By using such conditions, the risk of contact with water is reduced and the degradation of the active ingredient can be prevented or substantially reduced.
Binders suitable for use in pharmaceutical compositions and dosage forms include, but are not limited to, corn starch, potato starch, or other starches, gelatin, natural and synthetic gums such as acacia, sodium alginate, alginic acid, other alginates, powdered tragacanth, guar gum, cellulose and its derivatives (e.g., ethyl cellulose, cellulose acetate, carboxymethyl cellulose calcium, sodium carboxymethyl cellulose), polyvinyl pyrrolidone, methyl cellulose, pre-gelatinized starch, hydroxypropyl methyl cellulose, (e.g., Nos. 2208, 2906, 2910), microcrystalline cellulose, and mixtures thereof.
Suitable forms of microcrystalline cellulose include, for example, the materials sold as AVICEL-PH-101, AVICEL-PH-103 AVICEL RC-581, and AVICEL-PH-105 (available from FMC Corporation, American Viscose Division, Avicel Sales, Marcus Hook, Pa., U.S.A.). An exemplary suitable binder is a mixture of microcrystalline cellulose and sodium carboxymethyl cellulose sold as AVICEL RC-581. Suitable anhydrous or low moisture excipients or additives include AVICEL-PH-103(trademark) and Starch 1500 LM.
Examples of suitable fillers for use in the pharmaceutical compositions and dosage forms disclosed herein include, but are not limited to, talc, calcium carbonate (e.g., granules or powder), microcrystalline cellulose, powdered cellulose, dextrates, kaolin, mannitol, silicic acid, sorbitol, starch, pre-gelatinized starch, and mixtures thereof. The binder/filler in pharmaceutical compositions of the present invention is typically present in about 50 to about 99 weight percent of the pharmaceutical composition.
Disintegrants are used in the compositions of the invention to provide tablets that disintegrate when exposed to an aqueous environment. Too much of a disintegrant will produce tablets which may disintegrate in the bottle. Too little may be insufficient for disintegration to occur and may thus alter the rate and extent of release of the active ingredient(s) from the dosage form. Thus, a sufficient amount of disintegrant that is neither too little nor too much to detrimentally alter the release of the active ingredient(s) should be used to form the dosage forms of the compounds disclosed herein. The amount of disintegrant used varies based upon the type of formulation and mode of administration, and is readily discernible to those of ordinary skill in the art. Typically, about 0.5 to about 15 weight percent of disintegrant, preferably about 1 to about 5 weight percent of disintegrant, can be used in the pharmaceutical composition.
Disintegrants that can be used to form pharmaceutical compositions and dosage forms of the invention include, but are not limited to, agar-agar, alginic acid, calcium carbonate, microcrystalline cellulose, croscarinellose sodium, crospovidone, polacrilin potassium, sodium starch glycolate, potato or tapioca starch, other starches, pre-gelatinized starch, other starches, clays, other algins, other celluloses, gums or mixtures thereof.
Lubricants which can be used to form pharmaceutical compositions and dosage forms of the invention include, but are not limited to, calcium stearate, magnesium stearate, mineral oil, light mineral oil, glycerin, sorbitol, mannitol, polyethylene glycol, other glycols, stearic acid, sodium lauryl sulfate, talc, hydrogenated vegetable oil (e.g., peanut oil, cottonseed oil, sunflower oil, sesame oil, olive oil, corn oil, and soybean oil), zinc stearate, ethyl oleate, ethyl laureate, agar, or mixtures thereof. Additional lubricants include, for example, a syloid silica gel (AEROSIL 200, manufactured by W.R. Grace Co. of Baltimore, Md.), a coagulated aerosol of synthetic silica (marketed by Degussa Co. of Plano, Tex.), CAB-O-SIL (a pyrogenic silicon dioxide product sold by Cabot Co. of Boston, Mass.), or mixtures thereof. A lubricant can optionally be added, typically in an amount of less than about 1 weight percent of the pharmaceutical composition.
Desirably, each tablet contains from about 25 mg to about 150 mg of the active ingredient and each cachet or capsule contains from about 25 mg to about 150 mg of the active ingredient. Most preferably, the tablet, cachet, or capsule contains either one of three dosages, e.g., about 25 mg, about 50 mg, or about 75 mg of active ingredient (as scored tablets, the preferable dose form).